| Litvin Centers for Diabetes Newsletter |
Volume 32
September, 2008 |
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Dear Patients & Colleagues,
A recent discovery has claimed the ability to alter mouse pancreatic non-insulin producing cells to cells which are able to produce insulin by a method that involves inserting 3 different genes into the cells. The genes are inserted with the help of a virus, are incorporated by the DNA of the cell, and convert the cell into an insulin-producing cell!! All of this without stem-cell technology! Science is marching very fast towards the goal of having pancreatic beta cells available for the diabetic patient. Meanwhile, we have our first diabetic patient utilizing both the insulin pump and the glucose sensor. It's simply amazing to see the technical advancement of the insulin pump and how the glucose sensor reads the patient's glucose levels every 5 minutes! During the past 10 years enormous strides have been made toward a more perfect diabetic control, and more is yet to come....
Sincerely,
Dr. Litvin |
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Recent Diabetes News
Staggering Diabetes Stats!
The United States population of diabetics has recently increased to 24 million, according to the CDC. This comprises 8% of the population. Interestingly, the number of people that do not know that they have diabetes has decreased from 30% to 25%. It is estimated that 57 million people have pre-diabetes. The ethnic distribution is 16.5% among Native Americans, 11.8% in blacks, 10.4% in Hispanics, 7.5% in Asian Americans, and 6.6% in whites.
New Look at Screening and Diagnosing Diabetes Mellitus
The latest issue of the prestigious JCEM (The Journal of Clinical Endocrinology & Metabolism) has a feature article which is also a consensus statement by an important group of leaders in the field, about the above topic. They reason that diabetes is underdiagnosed, that 1/3 of the people that have it do not know about it, and that the average lag between the onset and the diagnosis is 7 years. Therefore, they set out to reconsider the criteria for diagnosing diabetes, and to recommend screening criteria for making "case finding" easier for clinicians and patients.
Their conclusions are: 1) Further screening should be prompted by a fasting glucose of 100 mg/dl or greater, random glucose of 130 mg/dl or greater, or HbA1c greater than 6.0%; 2) HbA1c of 6.5-6.9% or greater, confirmed by a fasting glucose or by an oral glucose tolerance test should establish the diagnosis; and 3) HbA1c of 7% or greater, confirmed by another HbA1c or a fasting glucose/glucose tolerance test, should establish the diagnosis of diabetes. These guidelines are a deviation from previous guidelines which did not take HbA1c into consideration.
Gastric Bypass Reduces HbA1c Levels in Diabetes
A study presented to the annual meeting of the American Society for Metabolic and Bariatric Surgery compared the outcomes of 51 type 2 diabetics who underwent the bypass procedure to 51 medically-managed type 2 diabetics. In the surgical group the A1c's dropped from a 7.6% level to 6.0%, whereas in the medically-managed group the A1c's increased from 7% to 7.8%! The surgical patients lost a mean of 103 lbs, or 68% of their excess weight, at 1 year. Body mass index (BMI) dropped from 48 to 31 in 1 year. Use of oral hypoglycemic agents was likewise dropped, concluding that remission from diabetes (defined as an HbA1c less than 6% and off diabetic medications) occurred at 1 year in 59% of surgical patients vs. in 35% of the conventionally treated group. Impressive, but not yet a mandate to treat all type 2's with surgery.
Closed-loop Artificial Pancreas
A recent article in Diabetes Care describes results of a study utilizing a closed-loop insulin pump with a glucose sensor in adolescents with type 1. The equipment was from Medtronic and included a MiniMed external pump and sensor with a variable insulin infusion rate algorithm designed to imitate/emulate the physiological characteristics of the beta-cell. Since insulin is delivered subcutaneously in this system (as in all external pumps), there is obviously a delay in insulin delivery, and therefore high post-meal glucose levels. To overcome this problem, researchers had subjects deliver a small premeal insulin bolus. Results of this study show that this closed-loop system holds promise, and was able to achieve a near-normal glucose profile. The future of diabetes care will certainly see a proliferation in the use of technology, so don't be surprised. |
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Medication, Gadgets & Lifestyle Info
Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women
In a study coming out of Tulane University in New Orleans, 71,346 female nurses aged 38-63 were followed for 18 years. They were free of heart disease, cancer or diabetes at the outset (1984), and dietary information was collected every 4 years. The diagnosis of diabetes was self-reported. During the follow-up, 4,529 nurses or 7.4% were documented as diabetic. An increase of 3 servings per day in total fruit and vegetable consumption, or an increase in whole fruit consumption alone, was associated with a lower hazard of diabetes, whereas the same change in fruit juice intake was associated with an increase hazard of diabetes. Fruit juice is replete with sugar (sucrose) and depleted of fiber, whereas whole fruits, of course, are the opposite. Therefore, stick to the natural stuff..
Nerve Signal-Blocking Device for Weight Loss
In a study published in "Surgery", a new implantable device that delivers a small electric impulse that blocks the Vagus Nerve has shown promise in causing significant weight reduction. The device is implanted via laparoscopy, and allows patients to flip a subcutaneous switch in order to activate it. Activation influences how the stomach digests food, according to the researchers. Over a six month period, participants showed almost a 15% mean excess weight loss. Caloric intake decreased by 30%, while participants experienced early satiety, and reduced hunger. Larger studies are currently underway in order to determine the potential for this approach, although in Europe a similar device (Metacure) has already been approved.
Sugar-Sweetened Beverages and Incidence of Type 2 Diabetes in African American Women
In a study following 59,000 African American women since 1995, researchers are reporting data from 43,960 women who gave complete dietary and weight information and were free from diabetes at baseline. Of these women, 3713 were diagnosed with diabetes. The incidence of diabetes was higher with higher intake of both sugar-sweetened soft drinks and fruit drinks. The authors concluded that regular consumption of such drinks is associated with an increased risk of type 2 diabetes mellitus in African American women. This sub-group of the population happens to be the most obese as well. It is obvious, therefore, that sugar-containing drinks must be OUT! |
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Cuisine Corner
Couscous and Black Bean Salad
1 ½ cups cooked whole-wheat couscous
1 can (15 ounces) black beans, rinsed and drained
1 cup cherry tomatoes
2 tablespoons minced fresh chives or green onion (green parts only)
1 tablespoon minced fresh cilantro
1 small jalapeno pepper, cored, seeded and minced (optional)
2 teaspoons white wine vinegar
1 teaspoon olive oil
¼ teaspoon salt
1/8 teaspoon black pepper.
Spoon couscous into large serving bowl. Add black beans. Cut tomatoes in half lengthwise, reserving 1 tablespoon tomato juice. Add tomatoes to couscous. Stir in chives, cilantro and jalapeno pepper, if desired. Mix gently but well. Stir together vinegar, reserved tomato juice, salt and black pepper, in small bowl. Mix well. Pour over salad. Toss gently but well. Makes 4 (3/4-cup) servings.
Nutrition Info: Calories 149, total fat 2g, saturated fat<1g, protein 7g, carbs 31g, cholesterol 0mg, dietary fiber 8g, sodium 550mg.
Recipe taken from Diabetic Cooking |
LCD News
Acupuncture at the Litvin Centers for Diabetes.
As some of you may know, we now have an acupuncture specialist at the Fort Lee location. Joan Choi, in addition to being a licensed acupuncturist is also a certified laser therapist and a certified herbalist. She offers both a needle, and a needleless procedure, and is available to address the multiple problems that our patient population faces. The problems that can be addressed are:
(1) weight control,
(2) smoking cessation,
(3) neuropathy with all of its manifestation,
(4) neurogenic bladder,
(5) circulation - both arterial and venous, and
(6) erectile dysfunction.
Data in the medical literature attests to success when this approach is used, in some of the patients. Since this approach is highly tolerable and does not involve taking any medication, I recommend that you give it a try. Call your insurance carrier to find out if these treatments are covered. If they are not, sessions are billed at $80.00 per session. Some problems may need only 2-3 sessions, others may need more. Please call Joan for an evaluation and scheduling at 201-655-1290. | |